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T ' <br /> San Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue , Stockton , California 95205 -6232 <br /> Telephone: ( 209 ) 468- 3420 Fax : ( 209 ) 468-3433 Web : www. sigov . orglehd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the " Notice to Comply" in the attached Inspection Report must be corrected within 30 days of <br /> receipt of this inspection . This certification form must be submitted to the Environmental Health Department ( EHD ) address <br /> at the top of this form within 30 days of receipt of the Inspection Report, HSC 25404 . 1 . 2 (c) ( 1 ) <br /> All corrections to other violations noted in the attached Inspection Report ( IR ) or Continuation Form , or disputes to any <br /> violations , are to be submitted using this certification and returned to EHD within 30 days unless otherwise specified in the <br /> Inspection Report , HSC 25185 (c) (3 ) <br /> with failing to comply by the above noted dates will be <br /> Note : All EHD staff time associated <br /> billed at the current hourly rate . <br /> For this certification to be complete , the operator of the site must include: <br /> A statement documenting what corrective actions were taken will be taken rorkfoor aach nd/or phoion <br /> tos verifying <br /> Copies of sample results/manifests/training records/other appropriate pap <br /> corrections <br /> Operator' s certification Carol Presto <br /> 2021 <br /> July 21 , Inspected By : <br /> Inspection Date : 10456027 <br /> Facility Address : 2420 W GRANT LINE RD CERS ID: <br /> I certify under penalty of law that: <br /> 1 . I have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. <br /> 2 . 1 have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION <br /> and I believe the information to be true , accurate , and complete: <br /> Photos Paperwork statement <br /> 3 . 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4 . 1 am aware that there are significant penalties for submitting false information , including the possibility of a fine <br /> andlor imprisonment for known violations . ( HSC 25191 ) <br /> Name: Title: <br /> Signature <br /> Date: Itr / I <br /> RECEIVED <br /> NIOV42 2 2021 <br /> ENVIRONMENTAL HEALTH <br /> DEPARTMENT r <br />